Manual therapy in the Training Room More than joint mobilization
6 modalities for your bag of “tricks” � Positional Release Therapy, (PRT) � Myofascial Release, (MFR) � Craniosacral Therapy, (CST) � Tui Na, (Chinese Massage) � Shiatsu, (Japanese massage) � Acupressure
PRT � Place the involved tissues in a position of comfort, (POC). � This reduces irritability of the tender point, (TP). � Ideal position is determined by the patients perception of reduced tenderness & the clinicians perception of reduced tone in the TP.
Effects of PRT � Normalization of muscle hyper tonicity � Normalization of fascial tension � Reduction of joint hypomobility � Increased circulation & reduced swelling � Decreased pain � Increased strength
Contraindications for PRT � Open wounds � Sutures � Healing fx’s � Hematoma � Hypersensitivity of the skin � Systemic or localized infection � Malignancy
Contraindications � Aneurysm � Acute rheumatoid arthritis
Conditions that respond to PRT � Patients with a distinct physical mechanism of injury, e.g. Sports injuries, motor vehicle accidents
4 Phases of Tx � Phase 1: acute phase--PRT can be used immediately after injury, due to the gentleness of the tx. � Phase 2: treating structural dysfunction in the acute and chronic pt. � Phase 3: restoration of functional movement � Phase 4: normalization of life activities
General Principles of tx � Anterior TP’s usually tx’d in flexion � Posterior TP’s usually tx’d in extension � TP’s near the midline tx’d with more flexion if anterior and more extension if posterior � TP’s lateral to midline tx with sidebending and rotation
Achieving the optimal position of comfort � Ultimate goal of PRT � Comfort zone, (CZ), is specific and different for each tx position
CZ has been reached when: 1) Reduction in tenderness noted 2) Palpable softness of tissues in area of TP. Perseverance is key when trying to eliminate a TP
TP & Position � Remember to maintain contact with TP while moving Patient into treatment position. � By maintaining contact-it is meant to be a gentle pressure on the TP, not increased pressure
TP, Position and Pressure � As CZ is approached increase pressure over TP periodically to monitor progress � When CZ is reached contact with TP is maintained, but non additional pressure is applied
POC � When in POC, patient should not have pain � If there is pain--then not in POC � Discomfort arising after POC is achieved is part of normal release process � This discomfort should subside after 1-3 minutes
POC � POC is maintained for 90 seconds � Once a TP has been fully released the body must be returned to neutral position SLOWLY.
PRT � Positional Release Therapy: assessment & treatment of Musculoskeletal Dysfunction--Kerry J. D’Ambrogio & George B. Roth.
Myofascial Release � “Fascia is a tough connective tissue that spreads throughout the body in a 3 dimensional web from head to foot functionally without interruption.” � Restrictions of the fascia can create pain or malfunction throughout the body.
MFR � “By requiring the therapist to respond to the subtle changes that occur in tissue tension during myofascial stretching, the therapist is able to work with the patient and not on the patient.”
MFR � “An athlete with fascial restrictions will not efficiently absorb the shocks of continued activity.” � “ connective tissue is composed of collagen, elastin and the polysaccharide gel complex, or ground substance. These form a 3 dimensional, interdependent system of strength, support , elasticity and cushion.”
MFR “ MFR along with therapeutic exercise and movement therapy improve the vertical alignment and lengthen the body,providing more space for the proper functioning of osseous structures, nerves, blood vessels and organs.”
Fascia � Is a slightly mobile connective tissue which is derived embryologically from mesoderm � Composed of an elasto-collagenous complex � The elastic component is stretchable & is the core of the complex
Fascia � The elasto-collagenous complex creates a 3 dimensional web, which runs from the top of the head to the tip of the toes. � Fascia surrounds every organ muscle, bone and nerve as well as blood vessels.
Elastocollagenous complex Elastic fibers Collagen fibers Relaxed Complex
Elastocollagenous Complex Stretched complex Collagen fibers Elastic fibers
Soft Tissue Mobilization � J-stroking � Vertical stroking � Strumming � Bear Claw
J Stroking & Vertical Stroking � Stroke in direction of the restriction ( with J stroke only) � Use counter pressure with one hand
Strumming � Downward pressure is applied with the fingertips and then a strumming motion is applied to the muscle tissue � Strumming if performed correctly is NOT a COMFORTABLE technique
Bear Claw � Is a form of strumming--used to clear the gluteal and hip regions.
Cross Hand Releases � Slowly stretch the tissue until you encounter a barrier � Maintain the stretch for 90-120 seconds or until you feel a release. � Do not try and force your way thru the barrier. � Follow thru the barrier until all is quiet
Arm Pull � This technique can be utilized with patients who have upper extremity dysfunction. � It can also be used to aid patients with cervical, thoracic and lumbar dysfunction
Anterior Thoracic Release � 2nd person maintains longitudinal traction thru the U.E.’s and follows the release 3 dimensionally. � Patient is in supine position.
Interscapular Release � Patient is in the prone lying position � Assistants maintain longitudinal traction thru the U.E.’s
Leg Pull � Leg pull can be utilized with patients with lower quadrant dysfunction, including lumbar and thoracic dysfunction
Lateral Thoracolumbar Release � 3 person technique- Pt. is sidelying-1 person and the top leg, 1 person on the top arm and 1 person on the chest.
Anterior thoracic Release � One assistant maintains traction thru both U.E.’s. � One person on the anterior chest
Interscapular Release � 3 person release- Pt. is in prone position--1 person on arm abducted to 90 degrees--1 person on scapula and 1 person on the opposite arm
Cervical Release � Patient in supine position with the head off of the table � Drop head into slight extension and apply gentle traction � Continue with head traction and apply caudad pressure to the chest � Maintain traction and apply caudad pressure top each shoulder.
MFR � Myofascial Release the search for excellence: John Barnes � The Myofascial Release Manual: Carol Manheim & Diane Lavett
Craniosacral Therapy � Based on the belief that the cranial bones move in relation to each other throughout life. � William Sutherland, an osteopath, became fascinated with the design of the cranial bones.
Basic Concepts of CST � Craniosacral system is a semi-closed hydraulic system � Boundaries formed by the meningeal membranes, ie the dura mater. � CSF intake via the choroid plexus � CSF returns to the venous system via the arachnoid villae.
“Listening Stations” � Heels � Dorsum's of the feet � Anterior thighs � ASIS � Ribs � Shoulders � Cranial vault-3 holds
Techniques for headache & Concussion � Occipital release � Frontal release � Sphenoid release � TMJ release
Release for Posterior of Temporalis � Sit at head of table � Arrange tips of fingers 2-4 over the tip of the ear,(ask pt. to clench teeth briefly and if I right place you will feel mov’t) � Apply medial pressure with cephalad traction
Temporalis cont’d � Apply moderate amount of medial pressure and without sliding pull fingertips superiorly � Maintain medial pressure and traction until you feel release
Masseter Release � Sit at head of table � Place thumbs over the masseter fibers and apply medial pressure until you get a release.
CST � CranioSacral Therapy: John E. Upledger & Jon D. Vredevoogd � CranioSacral Therapy ll: Beyond the Dura: John E. Upledger
Tui Na: Chinese Massage � Chinese massage and theory are inseparable. � Yin-yang theory: at the core of traditional Chinese medicine. � Yin and Yang are interdependent � The balance between Yin and Yang is not a fixed state
Techniques to use in the Training Room � Gun Fa--Rolling � Yi Zhi chan Tui Fa- one finger meditation � Rou Fa --kneading � Mo Fa -- round rubbing � Na Fa -- grasping � Cuo Fa-- rub rolling
Techniques cont’d � Ca Fa --scrubbing with palm or edge of hand � An Fa -- pressing with thumb or heel of palm � Ya Fa --suppressing with the elbow � Tui Fa --pushing with thumb, heel of hand or both palms
Techniques cont’d � Ma Fa --wiping � Ji Fa -- chopping using the edge of the hand, back of the hand or tips of the fingers � Zhenb Fa --vibrating with 1 finger, 2 fingers or the palm � Dou Fa -- shaking
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